The "Spiked Helmet" Sign Associated with ST-Elevation Myocardial Infarction: A Case Report

• Published in: Clinical practice and cases in emergency medicine Vol. 5; no. 2; pp. 152 - 154
• Main Authors: Minotti, Bruno, Scheler, Jörg, Sieber, Robert, Scheler, Eva
• Format: Journal Article
• Language: English
• Published: United States University of California Digital Library - eScholarship 01-05-2021; University of California Irvine, Department of Emergency Medicine publishing Western Journal of Emergency Medicine; eScholarship Publishing, University of California
• Subjects: Abdomen; Case Report; Electrocardiography; Emergency medical care; Medical imaging
• ISSN: 2474-252X; 2474-252X
• DOI: 10.5811/cpcem.2021.1.50921

The "spiked helmet" sign was first described in 2011 by Littmann and Monroe in a case series of eight patients. This sign is characterized by an ST-elevation atypically with the upward shift starting before the onset of the QRS complex. Nowadays the sign is associated with critical non-cardiac illness.
An 84-year-old man with a history of three-vessel disease presented to the emergency department with intermittent pain in the upper abdomen. The electrocardiogram revealed the "spiked helmet" sign. After ruling out non-cardiac conditions the catherization lab was activated. The coronary angiography revealed an acute occlusion of the right coronary artery, which was balloon-dilated followed by angioplasty. The first 24 hours went uneventfully with resolution of the "spiked helmet" sign. On the second day, however, the patient died suddenly and unexpectedly.
Despite the association with non-cardiac illness, the "spiked helmet" sign can be seen by an acute coronary artery occlusion as an ST-elevation myocardial infarction (STEMI). Reciprocal ST-depression in these cases should raise the suspicion of STEMI.